5.Bcg & Chemo


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5.Bcg & Chemo

  2. 2. BCG VACCINATION <ul><li>Calmette & Guerin , two French scientists who discovered BCG in 1906 </li></ul><ul><li>Attenuated avirulent strain of M. bovis </li></ul><ul><li>231 subcultures for 13 years </li></ul><ul><li>orally(1921to1925) </li></ul><ul><li>Intradermally(1927 onwards) </li></ul><ul><li>trials: </li></ul><ul><ul><li>regarding the efficacy and protective value of BCG </li></ul></ul><ul><ul><li>one particular trial was conducted in south India ( Chengalpet & Bangalore, 1968) </li></ul></ul>
  3. 3. AIM <ul><li>BCG vaccine </li></ul><ul><li>Induce primary artificial infection </li></ul><ul><li>Increases systemic immune response </li></ul><ul><li>Resistance to virulent TB bacilli </li></ul><ul><li>Decrease mortality and morbidity </li></ul>
  4. 4. VACCINE <ul><li>Live bacterial vaccine </li></ul><ul><li>Attenuated strain of M.bovis </li></ul><ul><li>DANISH 1331 recommended strain for vaccine production in BCG lab at Guindy, Chennai </li></ul><ul><li>The vaccine is stored in refrigerator at temperature <10 o C </li></ul>
  5. 5. TYPES <ul><li>Two types </li></ul><ul><li>Freeze dried </li></ul><ul><li>liquid vaccine </li></ul><ul><li>Freeze dried vaccine </li></ul><ul><ul><li>Stable vaccine </li></ul></ul><ul><ul><li>Present day vaccine in hospitals </li></ul></ul><ul><ul><li>Vaccine must be protected from sunlight exposure by wrapping in black cloth. </li></ul></ul><ul><li>Reconstituted vaccine </li></ul><ul><ul><li>By diluting the vaccine with normal saline </li></ul></ul>
  6. 6. <ul><li>DOSAGE </li></ul><ul><ul><li>for adult : 0.1mg in 0.1ml(intradermally) </li></ul></ul><ul><ul><li>For newborn(<4wks) : 0.05ml (skin thin and full dose  abscess formation) </li></ul></ul><ul><li>Administration </li></ul><ul><ul><li>By tuberculin syringe </li></ul></ul><ul><ul><li>Other techniques not </li></ul></ul><ul><ul><li>so much effective </li></ul></ul><ul><ul><li>Injected intradermally </li></ul></ul><ul><ul><li>at deltoid insertion </li></ul></ul><ul><ul><li>(inj too high or low </li></ul></ul><ul><ul><li> tender node formation) </li></ul></ul>
  7. 7. <ul><li>AGE </li></ul><ul><ul><li>India : at birth or at 6 weeks(along with DPT and Polio) </li></ul></ul><ul><ul><li>Early administration </li></ul></ul><ul><ul><li>Increase protection against childhood TB and TB meningitis </li></ul></ul>
  8. 8. Phenomena after vaccination <ul><li>Vaccine </li></ul><ul><li>Papule(2-3 wks after) </li></ul><ul><li>increase in size 4to8mm(in 5 wks) </li></ul><ul><li>shallow ulcer with crust formation </li></ul><ul><li>healing occur at 6to12 wks </li></ul><ul><li>scar 4-8mm in dia </li></ul>
  9. 10. COMPLICATIONS <ul><li>prolonged ulceration(1-10%) </li></ul><ul><li>suppurative lymphadenitis(1-10%) </li></ul><ul><li>osteomyelitis </li></ul><ul><li>disseminated BCG inf(<1%) </li></ul><ul><li>death </li></ul>
  10. 11. Ulcerated, 3 x 2 cm in diameter, erythematous, cutaneous nodule
  11. 12. COMPLICATIONS cont… <ul><li>after vaccination </li></ul><ul><li>local abcess formation </li></ul>may recover spontaneously may recover after aspiration if not recover after aspiration excise the abscess and locally apply PAS or INH powder daily
  12. 13. PREVENTION OF COMPLICATION <ul><li>to prevent the complication </li></ul><ul><ul><li>vaccine to be given intradermally </li></ul></ul><ul><ul><li>no vaccine into the same arm for 6 months </li></ul></ul>
  13. 14. EFFICACY OF BCG VACCINE <ul><li>preventing TB = 51% </li></ul><ul><li>preventing death = 71% </li></ul><ul><li>case control studies </li></ul><ul><ul><li>protective efficacy = 50% </li></ul></ul><ul><li>duration of protection = 15to20yrs </li></ul><ul><li>range of protection = 0-80% </li></ul>prospective trials
  14. 15. <ul><li>efficacy variation due to difference in </li></ul><ul><li>exposure of population to non Tuberculous bacilli </li></ul><ul><li>strains of BCG vaccine </li></ul><ul><li>age of administration </li></ul><ul><li>time of vaccination and development of TB </li></ul><ul><li>nutritional status of vaccine receipient </li></ul>
  15. 16. REVACCINATION <ul><li>revaccination has not been included in routine EPI of India </li></ul><ul><li>may be given at school age </li></ul>
  16. 17. CONTRAINDICATIONS <ul><li>inf. Dermatosis </li></ul><ul><li>eczema </li></ul><ul><li>hypogammaglobulinemia </li></ul><ul><li>immunocompromised </li></ul><ul><li>immunosuppressive ppl </li></ul><ul><li>pregnancy </li></ul>
  17. 18. direct BCG vaccination (without prior tuberculin test) <ul><li>has been adopted in India due to </li></ul><ul><ul><li>more rapid vaccination </li></ul></ul><ul><ul><li>complete coverage </li></ul></ul><ul><ul><li>reducing cost expense </li></ul></ul><ul><ul><li>no adverse reaction even if tuberculin positive </li></ul></ul><ul><ul><li>administered as quick as possible in infancy before exposing </li></ul></ul>
  18. 19. <ul><li>IMPACT </li></ul><ul><ul><li>BCG vaccination value < case finding and chemotherapy </li></ul></ul><ul><ul><li>Little value in TB prevention </li></ul></ul><ul><li>BCG VACCINATION AND HIV INFECTION </li></ul><ul><ul><li>Previously BCG vaccine can be given to all infants unless the child presented with symptomatic HIV </li></ul></ul><ul><ul><li>Presently, acc to GACVS recommend BCG should not be given to those infants who are asymptomatic HIV infection </li></ul></ul>
  19. 20. <ul><li>COMBINED VACCINATION </li></ul><ul><ul><li>Combined with OPV and DPT (in diff arm) </li></ul></ul><ul><ul><li>In industrialized countries, policy on BCG vaccination change in the upcoming years; BCG given only to high risk people. </li></ul></ul><ul><li>TO SUM UP </li></ul><ul><ul><li>BCG has more value in preventing childhood TB and TB meningitis and miliary TB </li></ul></ul>
  20. 21. CHEMOPROPHYLAXIS <ul><li>For childhood tb </li></ul><ul><ul><li>INH 5mg/kg OD for 1 year (protection for 30 years) </li></ul></ul><ul><li>For adult </li></ul><ul><ul><li>INH 300mg OD for 1 year </li></ul></ul><ul><ul><li>(now 9months) </li></ul></ul>
  21. 22. <ul><li>outcome </li></ul><ul><ul><li>INH prophylaxis reduces the risk upto 90% </li></ul></ul><ul><li>Chemoprophylaxis not effective in India </li></ul><ul><ul><li>Costly exercise </li></ul></ul><ul><ul><li>Not effective </li></ul></ul><ul><ul><li>INH induced hepatitis </li></ul></ul><ul><li>Conclusion </li></ul><ul><ul><li>BCG value > chemoprophyaxis </li></ul></ul>
  22. 23. THANK YOU